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Download Application Form
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Credit Card Authority Form |
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Date |
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Number of pages including cover sheet |
1
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To |
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Our Ref: |
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Your Ref:- |
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Phone |
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Fax |
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FROM: |
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Direct Dial |
0870 444 1916 |
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Direct Fax |
0870 444 1917 |
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I, …………………………….. give Live Telecoms Limited authority to use my Credit card for payment on orders faxed or placed verbally for goods to be purchased on behalf of the company name stated below. I also give Live Telecoms Ltd authority to use this card where any cheques collected upon delivery of goods do not clear or are not received by Live Telecoms Ltd.
Credit card number: ……………………………………..
Issue Number : ……………………………………..
CVV Number: (3 digits found on the reverse of the card) ……….
Start Date: ………./………
Expiry Date: ………./………
Card Type: VISA / MASTERCARD/SWITCH / DELTA / SOLO
(Circle where appropriate)
Registered Card Address:
Company Name:
Print Name: ……………………………………
Signed: ……………………………………
Call 0870 444 1916. Fax 0870 444 1917. |
